More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion: $80 billion for medical treatment and $326 billion for lost productivity. According to the CDC-funded National Study on the Costs and Outcomes of Trauma, the risk for death of a severely injured person is 25% lower if the patient receives care at a Level I trauma center vs. at a non-trauma center. Whether you live or die after being seriously injured is largely dependent on the level of split-second decision-making skill that your EMS provider and/or doctor possesses. At the scene of an injury, Emergency Medical Service (EMS) providers must identify the severity and type of injury, and determine which hospital or other facility would be the most appropriate to meet the needs of the patient. This is done through a process called “field triage.”
As they are the “tip of the spear” when it comes to affecting positive serious injury healthcare outcomes, we all have a vested interest in making sure that EMS responders make the most intuitive yet predictable decisions while in the field.
In 2004, the number of emergency department visits for nonfatal injuries exceeded 41 million, and more than 6.5 million injured patients (16%) were transported by ambulance. Effective field triage has the most direct impact on how many of those 6.5 million lives will be routed to the correct treatment facility.
In an attempt to standardize the emergency field triage decision process, the American College of Surgeons developed the Field Triage Decision Scheme(Decision Scheme), which serves as the basis for triage protocols for state and local EMS systems across the United States. Created in 1986, the Decision Scheme is an algorithm that guides EMS providers through four decision steps (physiologic, anatomic, mechanism of injury, and special considerations) to determine the most appropriate destination facility within the local trauma care system. Injured persons treated in emergency departments in 2000 accounted for $99 billion (24%) of the total cost of injury, with $32 billion in medical costs and $68 billion in productivity losses.
There are three specific field triage problems that the Decision Scheme seeks to address:
- Overtriage, which results in higher healthcare costs and wasted human resources. A review of data concerning ten terrorist bombings demonstrated a direct linear relationship between the rate of overtriage and the mortality rate of those critically injured.
- Since 1993, the number of hospitals with trained trauma centers has decreased significantly. When an ambulance transports a patient with minor injuries unnecessarily to a Level I trauma center thirty miles away instead of to a community hospital five miles away, the trauma center may have too few resources available to effectively respond to a real emergency.
- Non-emergency patient visits to trauma centers continue to rise. Many of these patients are uninsured. This issue is further complicated when you combine inadequate reimbursement from payers along with rising insurance costs.
Most of us have been witness to tragic events that involved the injury of people that we cared about. Typically the first person we interact with in those stressful situations is the EMS professional who assesses the situation and recommends a certain course of action. We all want our healthcare to come with maximum quality and reasonable costs. At the end of the day there are only two answers to two very important questions that matter.
How do we make sure that every treatment decision made during field triage is the correct one and, assuming perfection is not an option, how do we correct the error in time for it to matter?
What are your thoughts?
- The CDC-funded National Study on the Costs and Outcomes of Trauma.
- The Centers for Disease Control and Prevention (CDC) partnered with the National Highway Traffic Safety Administration and the American College of Surgeons to publish the “Guidelines for Field Triage of Injured Patients.”
- Accurate Field Triage of Injured Patients Saves Lives and Money.